Inability to open the mouth: An unusual psychosomatic symptom

Abstract

In applying field theory to psychosomatic disorders, in addition to the many familiar elements in the field, one must be attentive to the possible sequence of chronically disturbed function becoming causal in altering structure, sometimes irreversibly. This is a clinical report of two symptoms involving essentially the same anatomical area; one was reversible in the course of psychoanalytic treatment and one was not. The patient suffered from a severe stammer and a severe limitation in his ability to open his mouth. In the course of psychoanalytic treatment, the stammer was relieved, however the inability to open the mouth remained unchanged. The latter symptom was ultimately corrected surgically, after it was diagnosed as due to a mechanical obstruction of the passage of the coronoid processes of the mandibles under the zygomatic arches due to hypertrophy of the coronoid processes bilaterally. This paper makes an effort to understand this latter rare pathology as a psychosomatic entity and an extension of the same psychopathology as the stammer. The relationship between the patient's severe castration anxiety and the belated mechanical obstruction diagnosis and surgical treatment is also considered.